Low Confidence In Ability Research Articles

Evaluating the Impact of Gender and Race on Otolaryngology Resident Experiences Across the United States.

Otolaryngology residents often encounter work-related stress and challenges during training. Sociodemographic factors influence experiences during residency; however, the impact of race and gender on otolaryngology trainee well-being during residency remains understudied. Online survey. US residency programs. An anonymous online survey consisting of 59 multiple-choice questions was sent to 104 directors of Accreditation Council for Graduate Medical Education otolaryngology residency programs to distribute to residents. Respondents were queried regarding demographics and experiences with bias. Residents self-identified gender and race. Black, Hispanic/Latinx, Middle Eastern/North African, and multiracial residents were categorized as underrepresented minorities (URM). Sixty-oneUS otolaryngology residents responded to the survey, the majority of whom were women (60.7%) and white (62%). Many residents endorsed a belief that receipt of research and training opportunities was negatively impacted by bias due to race (29.5%) or gender (45.9%). More women (27%) than men (13%) reported maximal burnout, and fewer men (17.4%) than women (40.5%) expressed low confidence in ability to independently care for patients. More male (47.8%) and white (31.6%) residents strongly agreed they were thriving. 94.6% of women and 33.3% of URM residents reported being mistaken for a nonphysician, compared to 0% of white male respondents. Otolaryngology residents perceived differential treatment based on race and gender, with women and URM residents experiencing greater exclusion and bias, as well as increased misidentification and decreased ability to thrive. Future work includes increasing sample size for generalizability and developing interventions that uphold equity in residency training environments.

Factors influencing midwives' conversations about smoking and referral to specialist support: a qualitative study informed by the Theoretical Domains Framework.

The aim of this study was to identify factors influencing midwives' conversations about smoking, and referral to specialist smoking cessation services, using an evidence-based theoretical framework. Semi-structured, qualitative interviews were undertaken with community midwives employed within one health board region of Wales. Deductive framework analysis was employed by coding data to the domains of the Theoretical Domains Framework (TDF) and then identifying themes within domains and across participants. Seven midwives took part in the study. 13, out of a possible 14 domains, were mapped from the TDF. Key enablers to conversations and referrals include knowledge of the risks of smoking in pregnancy, congruence with the professional identity of a midwife, and the use of carbon monoxide monitors in initiating conversations and referrals. Limited knowledge of the specialist service, confusion about the opt-out pathway, varied skills in communicating and engaging with women, low confidence in ability to influence women's decisions, limited appointment times, and competing priorities were identified as barriers. Midwives recognise the importance of their role within the provision of smoking cessation advice and referral to specialist services. While there are continued time pressures and competing priorities for midwives, enhancing skills and confidence in collaborative, empowering approaches to addressing smoking would further support in optimising the uptake of maternity smoking cessation support. This could also enhance conversations about other public health issues such diet, physical activity, and alcohol use.

A population-based survey of self-reported delays in breast, cervical, colorectal and lung cancer screening

The early COVID-19 pandemic was associated with cessation of screening services, but the prevalence of ongoing delays in cancer screening into the third year of the pandemic are not well-characterized. In February/March 2022, a population-based survey assessed cancer needs in New Hampshire and Vermont. The associations between cancer screening delays (breast, cervical, colorectal or lung cancer) and social determinants of health, health care access, and cancer attitudes and beliefs were tested. Distributions and Rao-Scott chi-square tests were used for hypothesis testing and weighted to represent state populations. Of 1717 participants, 55% resided in rural areas, 96% identified as White race, 50% were women, 36% had high school or less education. Screening delays were reported for breast cancer (28%), cervical cancer (30%), colorectal cancer (24%), and lung cancer (30%). Delays were associated with having higher educational attainment (lung), urban living (colorectal), and having Medicaid insurance (breast, cervical). Low confidence in ability to obtain information about cancer was associated with screening delays across screening types. The most common reason for delay was the perception that the screening test was not urgent (31% breast, 30% cervical, 28% colorectal). Cost was the most common reason for delayed lung cancer screening (36%). COVID-19 was indicated as a delay reason in 15–29% of respondents; 12–20% reported health system capacity during the pandemic as a reason for delay, depending on screening type. Interventions that address sub-populations and reasons for screening delays are needed to mitigate the impact of the COVID-19 pandemic on cancer burden and mortality.

Qualitative Study of Practices and Challenges of Stepping Down Asthma Medication in Primary Care Across the UK.

BackgroundGuidelines recommend that asthma treatment should be stepped down to the minimally effective dose that achieves symptom control to prevent medication side effects and reduce unnecessary costs. Little is known about the practice of stepping down and the challenges in primary care, where most asthma patients are managed.ObjectiveTo explore views, experiences, barriers and ideas, of doctors, nurses and pharmacists working in primary care, related to step down of asthma medication.MethodsPrimary care practitioners from across the UK participated in a survey and/or semi-structured interview. Questions explored four main areas: how asthma medication is reviewed, views on asthma guidelines, perceived barriers faced by healthcare workers and facilitators of stepping down. Qualitative content analysis enabled data coding of interview transcripts to identify major themes.ResultsA total of 274 participants responded to the survey, 29 participated in an interview (12 doctors, 9 nurses, and 8 pharmacists), working in GP practices from across the UK. Nearly half of the survey participants infrequently step down asthma medication (doctors=42.7%, nurses=46.3%). Four major themes related to barriers to stepping down were (i) lack of awareness of the need to step down, (ii) inertia to step down, driven by low confidence in ability, fear of consequences, and concern for who is responsible for stepping down, (iii) self-efficacy of ability to step down, influenced by lack of clear, applied guidance and limited training, and (iv) feasibility of step down, driven by a lack of systematic acceptance of stepping down and time. Strategies proposed to reduce overtreatment included education and training, improved gathering of evidence and guidance, and integrating step down into routine asthma care.ConclusionFailure to implement this guideline recommendation into everyday asthma management is influenced by several contributing factors. Future directions should include addressing evidence gaps, implementing clear and practical guidance, integration of step-down assessment into the asthma review, and education of professionals and patients.

Reactions of women underscreened for cervical cancer who received unsolicited human papillomavirus self-sampling kits.

To evaluate experiences and reactions after receiving a mailed, unsolicited human papillomavirus self-sampling kit and identify psychosocial correlates of using kits. Survey participants were underscreened women aged 30-64 who were mailed human papillomavirus kits as part of a pragmatic trial at Kaiser Permanente Washington, a United States integrated health care system. Six months after the mailing, we invited kit returners and non-returners to complete a web survey that measured psychosocial factors (e.g. cervical cancer/human papillomavirus knowledge, attitudes toward screening), experiences, and reactions to kits. We compared responses between kit returners and non-returners. Comparing 116 kit returners (272 invited) and 119 non-returners (1083 invited), we found no clinically significant differences in psychosocial factors. Overall, survey respondents showed knowledge gaps in human papillomavirus natural history (82% did not know human papillomavirus infection can clear on its own) and interpreting human papillomavirus test results (37% did not know a human papillomavirus-negative result indicates low cancer risk). Kit returners found kits convenient and easy to use (>90%). The most common reason for non-return was low confidence in ability to correctly use a kit, although many non-returners (49%) indicated that they would consider future use. Women reported low trust in human papillomavirus testing to identify women at high risk for cervical cancer (52% in returners, 42% in non-returners). Screening programs could improve uptake and acceptability of human papillomavirus self-sampling through outreach materials that emphasize the high efficacy of human papillomavirus testing for cervical cancer screening and educate patients about how to interpret results.

Breastfeeding experiences and support for women who are overweight or obese: A mixed-methods systematic review.

Women who are overweight or obese have increased health risks during and beyond pregnancy, with consequences for their infants' shorter and longer term health. Exclusive breastfeeding to 6 months has many benefits for women and their infants. However, women who are overweight or obese have lower rates of breastfeeding intention, initiation, and duration compared with women with normal weight. This systematic review aimed to examine evidence of (a) breastfeeding barriers and support experienced and perceived by women who are overweight or obese, (b) support shown to be effective in increasing breastfeeding initiation and duration among these women, and (c) perceptions of health care professionals, peer supporters, partners, and family members regarding providing breastfeeding support to these women. Sixteen quantitative and qualitative papers were included and critically appraised. Thematic synthesis was undertaken to obtain findings. Maternal physical barriers such as larger breasts, difficulties of positioning to breastfeed, delayed onset of lactation, perceived insufficient supply of breast milk, and impact of caesarean birth were evident. Maternal psychological barriers including low confidence in ability to breastfeed, negative body image, embarrassment at breastfeeding in public, and experiencing stigma of obesity were also described. Support from health care professionals and family members influenced breastfeeding outcomes. Education for maternity care professionals is needed to enable them to provide tailored, evidence‐based support to women who are overweight or obese who want to breastfeed. Research on health care professionals, partners, and family members' experiences and views on supporting this group of women to breastfeed is needed to support development of appropriate interventions.

Barriers to correct child restraint use: A qualitative study of child restraint users and their needs

Motor vehicle crashes are a major cause of death and injury to children worldwide. Although risk of injury to child passengers can be reduced by using a child restraint, most restraints are incorrectly used. This greatly reduces the restraints’ protective potential; however there is limited research on drivers of correct child restraint use. The aim of this study was to explore perceived barriers and motivators of correct child restraint use in experienced child restraint users, to inform interventions to promote correct use. Motivations and risk perceptions concerning incorrect child restraint use among high and low socioeconomic populations and culturally and linguistically diverse (CALD) child restraint users in Sydney, Australia were qualitatively examined. Six focus groups (N = 44 participants) were facilitated using a semi-structured discussion guide. Transcriptions were deductively analysed using QSR NVivo11 software and the COM-B model of behaviour. Common perceived barriers to correct restraint use were: (a) difficulty interpreting instructions and labels, particularly among CALD participants; (b) remembering and attending to correct use information; (c) lack of information and behavioural feedback on how to correctly install and use a child restraint; and (d) low confidence in ability to install and use a child restraint correctly. The results indicate current child restraint product information is poorly understood, particularly among those whose first language is not English. Interventions to increase correct child restraint use should address access to correct use information, capability to understand and use these, and the influence of motivation, memory and attention in the process.

Development and Validation of the Questionnaire of Vaping Craving.

Craving may represent core motivational processes in tobacco dependence, but there is no psychometrically evaluated measure of craving for e-cigarettes (vaping craving). This research developed and validated a brief measure of vaping craving. The measure was evaluated in two studies. In Study 1, a 42-item questionnaire assessing a wide range of vaping craving content was administered to 209 current e-cigarette users. In Study 2, a 10-item questionnaire derived from Study 1 results was administered to 224 current e-cigarette users. Participants were recruited from Amazon's Mechanical Turk, an online labor market. Principal factor analysis identified the strongest loading items (.815-.867) on the first extracted factor (77% of the factor variance) for inclusion in a 10-item Questionnaire of Vaping Craving (QVC). This item set, with an internal consistency (α) of .97, focused on desire and intent to vape, and anticipation of positive outcomes related to e-cigarette use. Confirmatory factor analysis revealed the items had strong factor loadings that were significantly predicted by the latent vaping craving construct (ps < .001). Higher vaping craving was significantly associated with the level of e-cigarette use, greater negative mood, and lower confidence in ability to quit vaping (ps < .01). Among participants who also smoked tobacco (87%), vaping craving was more strongly associated with e-cigarette dependence than tobacco dependence. The findings support the reliability and validity of the QVC and suggest it could be used in laboratory and clinical settings as a psychometrically sound measure of vaping craving. This study is the first reporting the development and validation of a brief, practical, multi-item measure to assess vaping craving. This psychometrically sound assessment for vaping craving could improve understanding of the nature of vaping craving, advance current tobacco cessation strategies, and increase users' ability to cope with craving.

Beliefs about genetic influences on eating behaviors: Characteristics and associations with weight management confidence

IntroductionThe development of precision approaches for customized health interventions is a promising application of genomic discovery. To optimize such weight management interventions, target audiences will need to be engaged in research and implementation efforts. Investigation into approaches that engage these audiences will be required to ensure that genomic information, particularly with respect to genomic influences on endophenotypes like eating behavior, is understood and accepted, and not associated with unintended adverse outcomes. We took steps to characterize healthy individuals' beliefs about genetic influences on eating behavior. MethodsData were collected via online survey from 261 participants selected at random from a database. ResultsRespondents infrequently spontaneously identified eating behavior-related factors as running in families. However, those who perceived themselves as overweight and perceived a family history of overweight were more likely to attribute eating behavior to genetics on closed-ended assessments, β=0.252, p=0.039. Genetic attributions for eating behaviors were associated with lower confidence in ability to control eating and weight, β=−0.119, p=0.035. ConclusionsThese exploratory findings shed light on beliefs about genetic influences on eating, a behavioral trait (rather than a disease). This investigation can inform future health intervention efforts.

How Australian general practitioners engage in discussions about alcohol with their patients: a cross-sectional study

ObjectiveThis study aimed to investigate factors that inhibit and facilitate discussion about alcohol between general practitioners (GPs) and patients.DesignData analysis from a cross-sectional survey.Setting and participants894 GP delegates of a...

Internal medicine resident knowledge, attitudes, and barriers to naloxone prescription in hospital and clinic settings

ABSTRACTBackground: The United States is facing an epidemic of opioid use and misuse leading to historically high rates of overdose. Community-based overdose education and naloxone distribution has effectively trained lay bystanders to recognize signs of overdose and administer naloxone for reversal. There has been a movement to encourage physicians to prescribe naloxone to all patients at risk of overdose; however, the rate of physician prescribing remains low. This study aims to describe resident knowledge of overdose risk assessment, naloxone prescribing practices, attitudes related to naloxone, and barriers to overdose prevention and naloxone prescription. Methods: The HOPE (Hospital-based Overdose Prevention and Education) Initiative is an educational campaign to teach internal medicine residents to assess overdose risk, provide risk reduction counseling, and prescribe naloxone. As part of a needs assessment, internal medicine residents at an academic medical center in Baltimore, Maryland, were surveyed in 2015. Data were collected anonymously using Qualtrics. Results: Ninety-seven residents participated. Residents were overwhelmingly aware of naloxone (80%) and endorsed a willingness to prescribe (90%). Yet despite a high proportion of residents reporting patients in their panels at increased overdose risk (79%), few had prescribed naloxone (15%). Residents were willing to discuss overdose prevention strategies, although only a minority reported doing so (47%). The most common barriers to naloxone prescribing were related to knowledge gaps in how to prescribe and how to assess risk of overdose and identify candidates for naloxone (52% reporting low confidence in ability to identify patients who are at risk). Conclusions: Medicine residents are aware of naloxone and willing to prescribe it to at-risk patients. Due to decreased applied knowledge and limited self-efficacy, few residents have prescribed naloxone in the past. In order to improve rates of physician prescribing, initiatives must help physicians better assess risk of overdose and improve prescribing self-efficacy.

Once bitten, twice shy: concern about gaining weight after smoking cessation and its association with seeking treatment

Concern about weight gain after quitting smoking is often cited as a barrier to smokers making a quit attempt or seeking treatment. To identify whether smokers who are non-treatment seekers (NTS) are more concerned about weight gain and have lower confidence to maintain weight after quitting smoking as compared with treatment-seeking smokers (TS). Participants were smokers recruited from Penn State Hershey Medical Center and family practice outpatient clinics. A total of 102 NTS and 186 TS, who participated in a smoking cessation trial, completed a survey regarding tobacco use, weight concern and diet. Stepwise logistic regression was used to identify variables associated with treatment seeking, overall and stratified by those who gained and did not gain weight on a previous quit attempt. Fifty three per cent of the overall sample (47.1% NTS vs. 56.5% TS, p=0.127) had gained weight on a prior quit attempt. Among smokers who had gained weight, higher weight gain concern (WGC) and lower confidence in ability to maintain weight were significantly associated with being a NTS after adjusting for other factors. Among smokers who gained weight on a previous quit attempt, NTS had greater concern about gaining weight and less confidence in their ability to maintain their weight after quitting than treatment seekers. Clinicians can identify smokers for whom WGC may be a barrier to seeking treatment by asking if they gained weight on a previous quit attempt. These smokers should be assured that this issue will be addressed in treatment.

Turning Postgraduate Students’ Research Into Publications

The authors attempted to contact all 157 graduates from the University of Auckland's Master's in Public Health (MPH) program who completed theses from 1991 to 2005 about publications arising from their research. Of the 104 students contacted, 77 (74%) completed the questionnaire: 34 (45%) submitted a total of 46 articles, 31 (66%) of which were accepted or published. An expectation of publication and being supported financially were both associated with submission for publication. The most commonly reported barriers were lack of time (62%), lack of staff support (35%), and low confidence in ability to write (29%). For those regarding time as a barrier, work demands were commonly cited (90%). Sustained commitment from supervisors plus practical support (seminars, workshops, and cosupervision) was considered likely to be helpful. More effective supervisor-student engagement, funding, and setting an expectation of publication could increase MPH research outputs, but the additional supervisor workload must be realistic.

The relationship between eating self-efficacy and eating disorder symptoms in a non-clinical sample

Most research on eating self-efficacy has focused on its relationship with eating behaviors and weight-loss in clinical populations. The purpose of this study was to investigate the relationship between eating self-efficacy and the behavioral and psychological characteristics associated with eating disorders in a non-clinical sample of adults. A total of 219 men and women aged 18 and older completed questionnaires measuring eating disorder symptoms and eating self-efficacy. The results indicated that low confidence in the ability to control eating while experiencing negative emotions was associated with greater weight preoccupation and bulimic thought and behaviors. In addition, low confidence in ability to control eating when an abundance of food is available was inversely related to feelings of ineffectiveness or general negative self-evaluation. Ultimately, the findings suggest that low eating self-efficacy may also be associated with eating problems within populations not seeking treatment for either eating disorders or weight-loss. The implications of the findings are discussed.

Women Intending to Breastfeed: Predictors of Early Infant Feeding Experiences

We conducted interviews prenatally and postpartum with 187 women, all of whom intended to breastfeed their newborns. However, 18% of these women either never initiated breastfeeding or stopped within one week. Among women who initiated breastfeeding, we identified four variables as significant predictors of failure to breastfeed for more than seven days: lower confidence in ability to breastfeed, less certainty in the decision to breastfeed, delayed first breastfeeding experience, and lack of rooming in with the baby. Results of this study suggest that women at high risk for not implementing their prenatal breastfeeding intention can be identified for additional support; interventions should focus on prenatal confidence building, early and continuing contact with the newborn, anticipatory guidance prior to discharge, and early pediatric follow-up.

Determinants of breast self-examination among women of lower income and lower education

This study investigated breast self-examination (BSE) frequency and quality and determinants of BSE practice in two samples of women: (a) women of childbearing age who were of lower income and lower education and (b) women of childbearing age who were of higher income and higher education. Mothers recruited from a pediatric practice completed a questionnaire addressing BSE frequency and quality and factors derived from the Health Belief Model that might influence performance. Results indicated that there were no differences in mean BSE frequency or quality between the two samples. Regression analyses revealed that the perceived barriers index, consisting of forgetting, exclusive reliance on medical personnel for breast exams, and low confidence in ability to perform BSE, was the single best predictor of BSE frequency, accounting for 67% of the variance in each sample of women. When quality of BSE was examined, knowledge of BSE was the best predictor.